P0130 Combined modality therapy for patients with gastric non-hodgkin lymphoma: Updated long-term results

Abstract

Methods Clinical data were collected from 1980 to 2012 for 125 patients—64 male (51%) and 61 female (49%)—aged 21–75 years (median age 54.5 years). All patients with morphologically proven gastric non-Hodgkin lymphoma (NHL) received combined modality therapy. High grade lymphoma was present in 75 (60%) patients and low grade in 50 patients (40%). The distribution of International Prognostic Index (IPI) subgroups was as follows: 48 patients 0; 28 patients 1; 30 patients 2; 14 patients 3; 13 patients 4; and two patients 5. Treatment was prescribed according to contemporary protocols, including the following modalities: surgery in 50 patients (40%), chemotherapy in 108 (86%), and radiotherapy in 64 (51%). Disease-free survival (DFS) was analyzed with Cox regression models. Findings The following risk factors were analysed: sex, age, IPI, Karnofsky index, tumour grade, nodal involvement, and initial spread of the tumour. We found that IPI is one of the most valuable risk factors: in the IPI 3 subgroup, cumulative DFS was 14.85 times lower than in the IPI 0 subgroup (95% confidence interval [Cl] 3.649–68.591; p = 0.000), in the IPI (4 + 5) subgroup, it was 21.9 times lower than in the IPI 0 subgroup (95% Cl 5.372–82.733). Five year DFS in patients after surgery was 55 ± 3.6%. Five year DFS after chemotherapy was 46 ± 5.4%, and after radiotherapy it was 45 ± 4.2%. Patients after trimodal therapy (33 patients) had 5-year DFS of 96.7 ± 2.9%. 5-year DFS for patients treated with chemotherapy and radiotherapy, without surgery) was 20% lower (DFS 75 ± 3.2%) compared with those who received trimodal therapy, and cumulative DFS was 6.75 times lower (95% Cl 2.404–18.886; p = 0.000). Cumulative DFS in the group with no radiotherapy was 2.3 times lower versus the radiotherapy group (95% Cl 1.024–5.249; p = 0.044). Interpretation Surgery, alongside with radiotherapy and chemotherapy, has a significant role in therapy of gastric NHL, especially in high-grade subgroups.